JCPSLP July 2014_Vol16_no2

In light of the potential for confusion as to the role of the SLP in screening and assessing for (C)APD, the major objective of the present study was to conduct a survey to determine how SLPs in Queensland currently manage these aspects of (C)APD and to compare the results with published recommendations (ASHA, 2005). This study is the first of two articles arising from the survey, the second article considers how the surveyed SLPs treat (C)APD. Methods Participants Speech-language pathologists (SLPs, n = 1536) registered with the Speech Pathologists Board of Queensland were sent an email inviting those working with school-aged children with (C)APD to participate in an online survey. The email contained a link to an information sheet and a request for consent to participate in the study and access the survey. Seventy-one SLPs consented to participate in the study. Eleven of these participants either did not answer any of the survey questions or only responded to items requesting demographic information and their data were removed from analysis. Of the remaining 60 participants (4% of all SLPs registered in Queensland), 45 (75%) completed the survey and the remainder omitted responses to some questions. As a result, many questions had a lower response rate than 60. A decision was made to include participants who did not complete the entire survey as their responses offered useful information. The limitation of having only a small number of responses for some questions is acknowledged. Of the SLPs in Queensland who completed parts or all of the survey, the majority (40/60, 67%) indicated they held a Bachelors qualification in speech pathology, had practised as an SLP for >10 years (32/60, 53%), work in private practice or schools (53/58, 91%), work in Brisbane (33/56, 60%), work >30 hours per week (39/60, 65%), and have between 1% and 20% of their caseload being (C)APD (48/58, 83%). Just over half of the participants felt their university training in (C)APD did not adequately prepare them for managing cases of (C)APD (31/60, 52%) although a third (20/60, 33%) had been practising SLPs for more than 20 years. The majority of participants favoured a definition of (C)APD that emphasised difficulties processing basic acoustic information (i.e., sound) with potential flow- on effects to phonological and linguistic processing, which, in turn, could cause language and literacy impairments (36/58, 62%). Finally, the majority of participants reported adequate or better knowledge of what (C)APD is (50/58, 86%) and of the diagnostic tests used to assess for (C)APD (38/58, 66%), but not of evidence-based treatments for (C)APD (32/59, 54%). The raw data describing the participants is contained in the Appendix. Procedure The questionnaire was based on Emanuel et al. (2011) and included 72-items involving single and multiple responses, ratings scales, and open response questions. SurveyMonkey™ online survey software (http://www. surveymonkey.com) was used to deliver the questionnaire which remained “live” for four weeks during which time respondents were able to complete the survey only once. A reminder email was sent two weeks after the initial email had been sent. The questionnaire had been piloted with three SLPs serving as clinical educators within the home school of the researchers. Each of these educators had at least one year’s experience working with children with

(C)APD in that school’s speech pathology clinics. As a result of the pilot, minor changes were made to the content, formatting and timing of the questionnaire. In completing the final questionnaire, not all participants were asked every question as some items were skipped depending on how the participant responded to a previous question. There were 25 items designed to gather information about respondents’ demographics, understanding of (C)APD, and screening and assessment procedures. These are the focus of the current paper. The remaining 47 items pertained to specific treatment approaches and are reported elsewhere (Arnott, Henning & Wilson, 2014). Results The results obtained for questions about the respondents’ demographics, understanding of (C)APD, and screening and assessment procedures in the survey are displayed in Table 1 while the results for questions not reported in this table are provided in the Appendix. In this and the second paper in this series, the questions and response options have been presented in a shortened form, however, the full questionnaire and its results are available from the authors on request. Discussion More SLPs (61.4%) identified with a bottom-up model of (C)APD in which lower order auditory deficits underlie higher order listening, language, and learning problems than with a top-down model that holds that (C)APD and language/ literacy problems can coexist but are not causally related (26.3%). This finding is somewhat consistent with ASHA (2005) adopting a predominantly bottom-up approach to (C)APD but stating it can coexist with top-down deficits in cognition and language. It contrasts somewhat against other approaches such as the British Society of Audiology (2011), however, which claim there is no evidence to support the assertion that (C)APD results primarily from impaired bottom-up processing in the auditory system. Nearly two-thirds of the SLPs (60%) routinely referred a child suspected of having a (C)APD to an audiologist. The main clinical indicators used for referral were parent or teacher reports of classroom listening difficulties. The use of such functional indicators is supported by ASHA (2005), although ASHA warns that such indicators are not diagnostic for (C)APD. In contrast, Moore, Rosen, Bamiou, Campbell, and Sirimanna (2012) advocate the development of a standardised questionnaire similar to the Children’s Communication Checklist (Bishop, 2003) as a sensitive way for screening for auditory processing difficulties in children. Interestingly, of the 40% of clinicians who indicated that they do not usually refer a child for a (C)APD assessment, most of these (84%) stated the reason as being financial. In particular, these clinicians felt that the prohibitive cost to the parent was not justified as the diagnosis and report do not usually provide information that adequately informs their treatment planning. Some SLPs also cited school- related influences on their decision not to refer a child for a CAP assessment, including schools not prioritising this type of assessment, the education system not recognising (C)APD as a verifiable disability, and that the assessment results could jeopardise a diagnosis of speech-language impairment and associated funding in the Queensland state school system. Most SLPs indicated that they have never been contacted (72%) or are only occasionally contacted (24%)

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JCPSLP Volume 16, Number 2 2014

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